Provider Demographics
NPI:1114476678
Name:SIMCOX, MEREDITH ANN (RDN)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:ANN
Last Name:SIMCOX
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51014 ALMAFI CT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3323
Mailing Address - Country:US
Mailing Address - Phone:248-390-6678
Mailing Address - Fax:
Practice Address - Street 1:51014 ALMAFI CT
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3323
Practice Address - Country:US
Practice Address - Phone:248-390-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86009827133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered